Surgical instrument for grasping and cutting tissue

ABSTRACT

A surgical instrument for cutting and grasping tissue comprising a handle assembly, an elongated member and first and second jaws. A first movable member moves the second jaw in a first direction about a first pivot axis in a grasping action and a second movable member moves the second jaw in a second direction different than the first direction and about a second pivot axis in a cutting action. A switch is positioned at the proximal portion of the instrument and a selecting member is actuated by movement of the switch, the selecting member movable between a first position to enable movement of the second jaw in the first direction and prohibit movement in the second direction and a second position to enable movement of the second jaw in the second direction and prohibit movement in the first direction.

This application is a continuation of patent application Ser. No.13/935,836, filed Jul. 5, 2013, which is a continuation of patentapplication Ser. No. 13/751,071, filed Jan. 26, 2013, now abandoned,which is a divisional of patent application Ser. No. 12/322,729, filedFeb. 6, 2009, now U.S. Pat. No. 8,398,673, which claims priority fromprovisional patent application Ser. No. 61/066,063, filed Feb. 15, 2008.The entire contents of each of these applications are incorporatedherein by reference.

BACKGROUND OF THE INVENTION

Field of the Invention

This application relates to a surgical instrument and more particularlyto a surgical instrument for both grasping and cutting tissue.

Background

In minimally invasive surgery, the surgical procedure is performed byaccess to the surgical site through one or more small incisions. Thesurgical site is visualized by an endoscope inserted through one of theincisions and various surgical instruments are inserted through theincisions to manipulate the tissue as desired. The advantages ofminimally invasive surgery are well established which include improvedcosmesis, reduced chance of infection, faster patient recovery time andlower hospital costs.

Minimally invasive surgical procedures typically require the tissue tobe grasped and held or manipulated. These procedures also typicallyrequire the tissue to be severed. Currently, to perform cutting andgrasping functions separate instrumentation is required. This results inthe time consuming task of withdrawing one of the instruments from theincision (usually through an access port such as a trocar extending intothe patient) and inserting another instrument through the port. Not onlydoes this take up valuable surgical time, but there is an increasedchance of infection by passage of the instruments outside the body.There is also the risk of damaging tissue as the second instrument isinserted and advanced to the surgical site.

In these minimally invasive procedures, oftentimes the grasper jaws areused to dissect tissue. This can be achieved by opening the jaws todissect the tissue with their outer portion to create a working spacefor access to the surgical site. During this dissection and instrumentadvancement, a vessel may be encountered which requires severing toprovide further access to the surgical site. The surgeon sometimescauterizes the vessel to sever it, but such “excessive cauterization”could damage surrounding tissue. Another alternative utilized by thesurgeon is to remove the grasper and insert a pair of scissors or shearsto sever the vessel. This instrument exchange has the disadvantagesenumerated above. Additionally, after severing, to continue dissection,the scissors would have to be removed and a grasper reinserted. Ifanother vessel requires cutting, an exchange for a scissor would againbe necessary. As can be appreciated, multiple instrument exchanges couldoccur, thereby multiplying the foregoing risks. Some surgeons might tryto use the open scissor jaws for dissection, but there is a risk ofinadvertent cutting of tissue, so exchanging for a grasper is preferred.

Another example where currently instrument exchange between a scissorand grasper is necessary is in laparoscopic cholecystectomy. In thisprocedure, typically open jaws of the grasper are used to dissect aroundthe bile duct and then a clip applier extending through a differentaccess opening applies one or more clips on each side of the target areaof the duct. The surgeon then needs to remove the grasper and insert ascissor to cut between the clips. Next, the scissors need to be removedso that graspers can be inserted to remove the gall bladder. As can beappreciated, exchanges of the grasping and cutting instrument arerequired.

It would be advantageous to provide a single instrument which achievesboth cutting and grasping which would thereby avoid the disadvantagesenumerated above of instrument exchanges. This was recognized in U.S.Pat. Nos. 6,391,043 and 7,410,494, commonly owned with the presentapplication. However, there are several disadvantages associated withthe instruments of these two patents. The present inventionadvantageously overcomes the disadvantages of these instruments andprovides an instrument for both cutting and grasping tissue whichprovides significant manufacturing and clinical advantages.

SUMMARY OF THE INVENTION

The present invention provides an instrument capable of both cutting(severing) tissue and grasping tissue using the same pair of jaws. Theinstrument may also advantageously have a uniquely designed ergonomichandle assembly which eases manipulation of the instrument jaws. Theinstrument may also advantageously have a safety to ensure the jaws arein their closed position when they are switched between the cutting andgrasping functions. Still further, the instrument may furtheradvantageously have a built in mechanism to prevent movement of the jawsin a cutting action when a grasping action is selected and preventmovement of the jaws in a grasping action when a cutting action isselected.

The present invention provides in one aspect a surgical instrument forcutting and grasping tissue comprising a handle assembly disposed at aproximal portion of the instrument, an elongated member extending fromthe handle assembly, a first jaw positioned adjacent a distal portion ofthe elongated member, and a second jaw positioned adjacent the distalportion of the elongated member and mounted for movement with respect tothe first jaw. A first movable member is operably associated with thesecond jaw and is movable between first and second positions to move thesecond jaw in a first direction about a first pivot axis in a graspingaction. A second movable member is operably associated with the secondjaw and movable between first and second positions to move the secondjaw in a second direction different than the first direction and about asecond pivot axis in a cutting action. A switch is positioned at theproximal portion of the instrument and a selecting member is actuated bymovement of the switch. The selecting member is movable between a firstposition to enable movement of the second jaw in the first direction andprohibit movement in the second direction and a second position toenable movement of the second jaw in the second direction and prohibitmovement in the first direction.

Preferably, the instrument further comprises first and second lockingmechanisms wherein the selecting member comprises a rotatable linkingmember movable for selective engagement of one of the first and secondlocking mechanisms.

In a preferred embodiment the instrument includes a first gear operablyassociated with the first movable member, a second gear operablyassociated with the second movable member, a first locking memberengageable with the first gear and a second locking member engageablewith the second gear, the selecting member selectively moving one of thefirst and second locking members into engagement with its respectivegear.

In a preferred embodiment, the first jaw has a first upper surface witha first edge and a second edge and the second jaw has a second lowersurface with a third edge and a fourth edge, wherein in a cuttingaction, the first and third edges pass each other in substantiallyparallel planes and in a grasping action the first and third edges pivotaway from each other in transverse planes. In a preferred embodiment,the first pivot axis and the second pivot axes intersect and aresubstantially perpendicular.

The instrument may include a linkage mechanism having multiple linkslinking the switch to the selecting member.

In a preferred embodiment, the instrument may include a safety mechanismoperably associated with the switch to prevent movement of the switch ifthe jaws are not in a closed position.

In a preferred embodiment, both the first jaw and second jaws aremovable by the movable members.

In a preferred embodiment, a first handle is operably associated withthe first movable member, a second handle is operably associated withthe second movable member, and the first movable member comprises afirst tubular member and the second movable member comprises a secondtubular member, the tubular members preferably being coaxial.

In another aspect, the present invention provides a surgical instrumentfor cutting and grasping tissue comprising an elongated member, a firstjaw positioned adjacent a distal portion of the elongated member, and asecond jaw positioned adjacent the distal portion of the elongatedmember and mounted for movement with respect to the first jaw. A firstmovable member is operably associated with the second jaw and is movablebetween first and second positions to move the second jaw in a firstdirection in a grasping action. A second movable member is operablyassociated with the second jaw and is movable between first and secondpositions to move the second jaw in a second direction different thanthe first direction in a cutting action. A switch is positioned at aproximal portion of the instrument. A handle assembly includes astationary grip, a first actuator and a second actuator, wherein thefirst actuator is operably associated with the first movable member tomove the second jaw in a grasping action and the second actuator isoperably associated with the second movable member to move the secondjaw in the cutting action.

In one embodiment, the first actuator is positioned proximal of thestationary grip and the second actuator is positioned distal of thestationary grip.

In a preferred embodiment, the first actuator is operably associatedwith a first gear mechanism and the second actuator is operablyassociated with a second gear mechanism.

In a preferred embodiment, the switch is movable between first andsecond positions, wherein in the first position the switch enablesmovement of the second jaw in the first direction and prohibits movementin the second direction and in the second position the switch enablesmovement of the second jaw in the second direction and prohibitsmovement in the first direction. In a preferred embodiment, first andsecond locking elements are operably associated with the switch toprohibit movement of the first or second actuator, depending on theposition of the switch.

In another aspect, the present invention provides a surgical instrumentfor performing first and second different functions on tissue comprisingan elongated member, a first jaw positioned adjacent a distal portion ofthe elongated member, and a second jaw positioned adjacent the distalportion of the elongated member and mounted for movement with respect tothe first jaw. The first and second jaws are movable between open andclosed positions in a first orientation and are further movable betweenopen and closed positions in a second different orientation. A firstactuating mechanism moves the jaws in the first orientation and a secondactuating mechanism moves the jaws in the second orientation. A switchis provided for choosing the first or second actuating mechanism,wherein the switch can be activated only when the jaws are in the closedposition.

In one embodiment, the first function is cutting and the second functionis grasping. In this embodiment, preferably the first jaw has a firstupper surface with a first edge and a second edge and the second jaw hasa second lower surface with a third edge and a fourth edge, wherein whenthe jaws move between open and closed positions in the first orientationto perform the cutting function, the first and third edges pass eachother in substantially parallel planes and when the jaws move betweenopen and closed positions in the second orientation in the graspingfunction, the first and third edges pivot away from each other intransverse planes.

In one embodiment, movement of the switch moves a link in a clockwise orcounterclockwise direction to effect operative engagement of one of theactuating mechanisms to prevent movement thereof.

The instrument may include a safety member operably associated with theswitch, the safety member movable between a first position to lock theswitch against movement and a second position to allow movement of theswitch, the safety automatically locking the switch when the jaws are inthe open position. In one embodiment, the safety includes a slidingmember engageable with the switch in a proximal position.

In another aspect, the present invention provides a surgical instrumentfor performing first and second different functions comprising a handleassembly disposed at a proximal portion of the instrument, an elongatedmember extending from the handle assembly, a first jaw positionedadjacent a distal portion of the elongated member and a second jawpositioned adjacent the distal portion of the elongated member andmounted for movement with respect to the first jaw. A first movablemember is operably associated with the second jaw and movable betweenfirst and second positions to move the jaws in a first direction about afirst pivot axis to perform a first function on tissue. A second movablemember is operably associated with the second jaw, the second movablemember movable between first and second positions to move the jaws in asecond direction different than the first direction and about a secondpivot axis to perform a second different function on tissue. The secondmovable member is positioned within the first movable member. A switchis positioned at the proximal portion of the instrument to switch theinstrument between the first and second functions.

In one embodiment, the first jaw has a first projecting member extendingin a first direction engageable by the first movable member and a secondprojecting member extending in a second different direction engageableby the second movable member and the second jaw has a third projectingmember extending in a first direction engageable by the first movablemember and a fourth projecting member extending in a second differentdirection engageable by the second movable member. In one embodiment,the first and third projecting members lie substantially along the sameaxis and the second and fourth projecting members lie substantiallyalong the same axis.

The present invention also provides in another aspect a handle assemblyfor a surgical instrument having first and second jaws. The handleassembly comprises a stationary handle, a first actuator, a secondactuator and a switch. The first actuator has a first movable fingerloop configured to receive a thumb of the user and is operablyassociated with a first movable member to effect movement of at leastone of the instrument jaws in a grasping action. The second actuator hasa second movable finger loop and is operably associated with a secondmovable member to effect movement of at least one of the instrument jawsin a cutting action. The first and second actuators and the switch areall operable by a single hand of a user, wherein the switch cannot beactivated by the single hand of the user unless the user releases thethumb engagement of the first finger loop.

The handle assembly preferably further comprises a stationary handlepositioned between the first and second actuators and having a thirdstationary finger loop.

The present invention also provides a surgical method of grasping andcutting tissue with a single instrument comprising:

-   -   providing an instrument having first and second jaws movable in        a first orientation to perform a grasping function and movable        in a second orientation to perform a cutting function;    -   moving a first actuator of the instrument to move the jaws in        the first orientation between closed and open positions to grasp        tissue;    -   moving a second actuator of the instrument to move the jaws in a        second orientation between closed and open positions to cut        tissue;    -   moving a switching mechanism between first and second positions        to select the grasping or cutting function, wherein the        switching mechanism can only be moved when the jaws are in the        closed position.

In one embodiment, the step of moving the switching mechanism in thesecond position moves a first locking member into engagement with anadvancing mechanism for moving the jaws in the first orientation. In oneembodiment, the step of moving the switching mechanism in the firstposition moves a second locking member into engagement with an advancingmechanism for moving the jaws in the second orientation.

DETAILED DESCRIPTION OF THE DRAWINGS

Preferred embodiment(s) of the present disclosure are described hereinwith reference to the drawings wherein:

FIG. 1 is a perspective view of a first embodiment of the surgicalinstrument of the present invention showing the grasper handle and thecutting handle in the at rest position with the jaws in the closedposition;

FIG. 2 is an exploded view of the handle assembly of the instrument ofFIG. 1, showing one of the housing halves;

FIG. 3 is an exploded view of the jaw assembly and distal portions ofthe jaw actuators of the instrument of FIG. 1;

FIG. 4 is a perspective view of the actuators and switching mechanismcorresponding to the position of the instrument of FIG. 1 and showingthe switch in the grasping function position;

FIG. 5 is a perspective view of the jaws in the closed positioncorresponding to the position of the actuators of FIG. 4;

FIG. 6 is a perspective view similar to FIG. 1 showing the grasperhandle in the retracted position and the jaws in an open graspingposition, the switch remaining in the grasping function position;

FIG. 7 is a view similar to FIG. 4 showing retraction of the grasperactuator to move the jaws to an open grasping position, andcorresponding to the position of the instrument of FIG. 6;

FIG. 8 is a perspective view of the jaws in the grasper open positioncorresponding to the actuator position of FIGS. 6 and 7;

FIG. 9 is a perspective view similar to FIG. 4 showing the switchingmechanism in the cutting function position and the jaws in the closedposition, and further showing the grasper spur gear locking the graspergear to prevent movement of the grasper handle;

FIG. 10 is a perspective view of the instrument similar to FIG. 6showing the grasper handle in the at rest position to close the jaws andthe switching mechanism moved to the cutting function position;

FIG. 11 is a perspective view of the jaws of the instrument of FIG. 1 inthe open cutting position;

FIG. 12 is a view similar to FIG. 9 illustrating movement of the cutterhandle to move the jaws to the closed position (the switch remaining inthe cutting function position);

FIG. 13 is a perspective view of the jaws in the closed position aftermovement from the open position of FIG. 11 in a scissors action;

FIG. 14 is a perspective view of an alternate embodiment of the jawshaving a series of teeth and a raised cutting surface;

FIG. 14A is a close up view of the area of detail of FIG. 14;

FIG. 14B is a perspective view similar to FIG. 14 showing the other sideof the jaw assembly;

FIG. 15 is a perspective view of an alternate embodiment of theinstrument of the present invention having a locking plate to preventmovement of the switching mechanism if the jaws are not in the closedposition, the locking plate shown in the nonengaged position to allowmovement of the switch; and

FIG. 16 is a perspective view similar to FIG. 15 showing the lockingplate in the engaged position to prevent movement of the switch from thecutting function position to the grasping function position;

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Turning now to the drawings, wherein like reference numerals identifysimilar or like components throughout the several views, a surgicalinstrument is designated generally by reference numeral 10. Throughoutthe description, the term “proximal” will refer to the portion of theinstrument closer to the user and the term “distal” will refer to theportion of the instrument further from the user.

Turning first to FIG. 1, the surgical instrument 10 has a handleassembly 30 at its proximal portion 11, an elongated member or shaft 20extending distally from the handle assembly 30 and a jaw assembly 100 atthe distal portion 13. The jaw assembly 100 includes a first jaw 110 anda second jaw 120 which are operably connected to the handle assembly 30.In the orientation of FIG. 1, the first jaw 110 forms the lower jaw andthe second jaw 120 forms the upper jaw. A rotating knob 26 adjacent thehandle assembly 30 and at a proximal region of the elongated shaft(outer tube) 20 rotates the shaft 20 and thereby the jaws 110, 120 ofthe instrument 10 about a longitudinal axis of the shaft 20. A rockerswitch 51 of switching mechanism 50 (FIG. 2) enables switching between agrasping and cutting function of the jaws 110, 120 as described in moredetail below. A receptacle 34 for a conventional monopolar cautery plugoptionally extends from the top of the body of handle assembly 30.

The jaws 110, 120 are movable in a first orientation to perform acutting function and movable in a second different orientation toperform a grasping function. Thus, the jaws move in different planes tocut (sever) tissue and to grasp tissue. More specifically, in a graspingaction, jaws 110 and 120 pivot about a first pivot axis in planes atacute angles to each other so the upper surface 112 of lower jaw 110 andthe lower surface 124 of upper jaw 120 move away from each, forming anacute angle in the open position. Stated another away, the opposingedges or walls 110 a, 110 b of jaw 110 and opposing edges 120 a, 120 bof jaw 120 to move downwardly and upwardly, respectively, away from eachother. This is depicted in FIGS. 5 and 8 wherein the jaws 110, 120 areshown in FIG. 5 in a closed configuration and in FIG. 8 in an opengrasping position.

In a cutting action, the first and second jaws 110, 120 pivot about asecond pivot axis such that the upper surface 112 of jaw 110 and lowersurface 124 of jaw 120 move away from each other in substantiallyparallel planes in a scissor-like action. In this manner, edge 110 b oflower jaw 110 which has a sharpened surface 111 interacts with an edgeof upper jaw 120 opposite edge 120 b which has a sharpened surface. Thisis shown in FIGS. 11 and 13 wherein the jaws 110, 120 are shown in theopen and closed positions, respectively. When moved to the closedposition, the sharpened surface 111 on edge 110 b of lower jaw 110passes by the sharpened surface on the lower edge of upper jaw 120.(Note this sharpened edge of upper jaw 120 is not visible in FIG. 11 asit is opposite edge 120 b; however the sharpened edge is shown in theupper jaw of the alternate embodiment of FIG. 14 discussed below).

As shown in FIG. 5, the first and second pivot axes, i.e. axis D aboutwhich the jaws 110, 120 move in the grasping orientation and axis Aabout which the jaws move in a cutting orientation, intersect a centerpoint C and are preferably substantially perpendicular.

Although both jaws are shown and described as moving in the cutting andgrasping action, it is also contemplated that alternatively only one ofthe jaws could move in the grasping action and/or cutting action withthe other jaw remaining fixed. Therefore relative movement of the jawsas used herein refers to one of the jaws moving with respect to theother fixed jaw or both of the jaws 110, 120 moving between theirvarious positions.

With reference to FIG. 3, a lower projecting member or pin 113 extendsfrom the lower surface 114 of lower jaw 110 and is configured to engageopening 131 b in yoke half 136 b for movement of the jaw 110 in agrasping action (FIG. 8). A side projecting member or pin 115 engagesthe cutter tube 150 (described below) for movement of the jaw 110 in acutting action (FIG. 11).

Lower jaw 110 has a proximal upper recess 119, preferably substantiallyhemi-spherical as shown to receive a ball 132 of shaft 130. The shaft130 and ball 132 are held in tension by tension spring 133 (see e.g.FIG. 4) to remove the tolerances, i.e. reduce the play of the jaws. Jaw110 also has a linear region 118 a and an arcuate region 118 b.

Upper jaw 120 is similar to lower jaw 110 and has an upper surface 122opposite lower surface 124. An upper projecting member or pin 123extends from the upper surface 122 and is configured to engage opening131 a in yoke half 136 a for movement of the jaw 120 in a graspingaction. A projecting member or side pin 125 engages the cutter tube 150(described below) for movement of the jaws 110 in a cutting action. Notethat side pins 115 and 125 extend from opposing sides of the jawassembly 100. Preferably pins 113 and 123 lie substantially along thesame axis and pins 115 and 125 lie substantially along the same axis.

Upper jaw 120 has a proximal lower recess similar to recess 119 of jaw110, preferably substantially hemispherical, to receive ball 132 ofshaft 130. Jaw 120 has a linear region 128 a and an arcuate region 128b.

Preferably both jaws are movable, however, as noted above, it is alsocontemplated that one of the jaws could be fixed and the other movable.Also, other configurations of the jaws other than curved as shown arealso contemplated. In the embodiment of FIG. 3, the jaws are shown withblunt tips.

Each of the jaws preferably has a series of teeth shown for example inthe preferred alternate embodiment of FIG. 14. As shown, lower jaw 210has teeth 211 on upper surface 213 and upper jaw 220 has teeth 221 onlower surface 227. Preferably the teeth 211, 221 extend substantiallytransversely to a longitudinal axis of the jaws 110, 120. The edge 215of the lower jaw 210 has a raised rib 216 with a cutting surface. Theupper jaw 220 has a raised rib 226 on its lower surface 227 of the edge228 opposite edge 225 with a cutting surface to interact with thecutting surface of raised rib 216 when the jaws 210, 220 are moved in ascissor like fashion to sever tissue in the manner of FIGS. 11 and 13.The raised ribs 216 and 226 on the lower and upper jaws, respectively,illustratively extend beyond the plane of the respective teeth 211, 221so as not to interfere with the scissors action of jaws 210, 220. In allother respects, including their configuration and actuation, jaws 210,220 are identical to jaws 110 and 120 of FIG. 1.

The switching mechanism 50 for selectively locking the cutter orgrasping gear mechanism of the instrument will now be described. Withreference to FIGS. 2, 4, and 9, the switching mechanism 50 includes arocker switch 51 positioned at a proximal portion of the instrument andhaving a pair of detents 51 a engagable with a respective recess 33 a or33 b in the housing 32 of handle assembly 30. A mounting pin 52 aextends outwardly from each side of switch 51 and engages aperture 39 ain housing half 32 a and a similar aperture (not shown) in the otherhousing half 32 b. Such mounting to the housing 32 provides for pivoting(rocking) movement of the switch 51. Note that only one of the housinghalves, half 32 a, is shown in FIG. 2; the other half 3 b is not shownfor clarity and is the mirror image of housing half 32 a. Therefore onlythe mounting to housing half 32 a will be described, it being understoodthat the components are mounted to housing half 32 b in the same manner.

The detents 51 a of switch 51 retain the rocker 51 in either a firstposition where the jaw grasping function is locked out or a secondposition where the jaw cutting function is locked out. This is achievedby engagement in either upper recess 33 b of housing 32 a (and housing32 b) for the cutting function or a lower recess 33 a for the graspingfunction. The detents 51 a can be retained in positions other than thoseshown e.g. a neutral position) and two or more detents can be providedand the detents can be provided in other parts of the switch. Other waysto retain the switch in its positions could also be provided. The switch51 can include a curved indentation 54 which can have a knurled orirregular surface to facilitate actuation by the surgeon's thumb.

The switching mechanism 50 further includes a linkage mechanism operablyassociated with the rocker switch 51, best shown in FIGS. 2, 4 and 9.More specifically, the linkage mechanism includes a switch connectinglink 56, a pair of rear (first) intermediate links 60 a, 60 b, a front(second) intermediate link 64, and a curved gear link 70. Link 56 isconnected to an upper extension portion of rocker 51 via pin 56. Rearintermediate links 60 a, 60 b each have a pin for attachment to a frontend of link 56. Rear intermediate links 60 a, 60 b are attached to arear portion of front intermediate link 64 via pin 64 b extendingthrough opposing openings in link 64. Pin 64 b is mounted within opening36 c in housing half 32 a (as well as the other housing half 32 b). Thefront intermediate link 64 has front holes aligned with the holes onextension 72 of curved link 70 for attachment to curved link 70 via pin64 a. Note in FIGS. 2, 4 and 7, the switching mechanism is in thegrasping function position. In FIGS. 9 and 12, the switching mechanismis in the cutting function position.

A safety mechanism 160 is preferably provided to ensure the switchingmechanism 50 cannot be activated unless the jaws 110, 120 are in theclosed position. This is described in more detail below in connectionwith the alternate embodiment of FIG. 15.

Curved gear link 70 has a pair of rear holes and a pair of front holesto receive gear pins 77, 79, respectively. Central mounting holes 73 oflink 70 receive housing pins 35 on each housing half 32 a, 32 b (oralternatively a single pin trapped between the housing halves) formovably (pivotably) mounting curved gear link 70 to the housing 32.

Curved link 70 moves in a rocker type fashion, pivoting about housingpin 35 connected in holes 73, preferably centrally disposed in link 70,to selectively engage one of the gear mechanisms. In this rockingmovement, the curved link 70 moves between one position to effectengagement of the grasper gear mechanism and another position to effectengagement of a cutter gear mechanism, both described below.

The gear mechanism of the present invention provides a system foradvancing the respective actuator tubes for opening and closing the jawsin a grasping or in a cutting function. The gear mechanism is alsoselectively lockable to lock movement of one of the actuator handles andrespective actuator tubes while enabling movement of the other actuatorhandle and respective tube.

With continued reference to FIGS. 2, 4 and 7, the gear mechanismincludes an upper grasper spur gear 82, lower grasper inverted spur gear85 and a grasper gear 84. The gear mechanism further includes an uppercutter spur gear 86, inverted cutter spur gear 89 and cutter gear 88positioned distally of the grasper gears 82, 84, and 85. As shown,preferably the teeth 84 a, 88 a of gears 84, 88 extendcircumferentially.

The handle assembly is operably associated with the gears 84 and 88 suchthat movement of one of the handles moves the respective gears which inturn actuates a connected movable member, e.g. an actuator tube orshaft, to open and close the jaws. This is described in more detailbelow in connection with the discussion of the handle assembly.

The spur gears 82 and 86 of the gear mechanism 80 form lockingmechanisms to selectively lock the respective gear 84, 88 againstmovement. In this manner, when a cutting action is desired, the rockerswitch 51 is activated, i.e. manually actuated by the user to pivotabout pivot pin 52 a, to move the links of the switching mechanism 50 sothat the teeth 82 a of the grasper spur gear 82 mesh with the teeth 84 aof grasper gear 84 to lock the grasper gear 84 against movement. Thisprevents movement of the grasper handle actuator 40 and is shown inFIGS. 9 and 12. When a grasping action is desired, the rocker switch 51is activated to move the links of the switching mechanism 50 so that theteeth 86 a of the cutter spur gear 86 mesh with the teeth 88 a of thegrasper gear 88 to lock the grasper gear 88 against movement. Thisprevents movement of the cutter handle actuator 46 and is shown in FIGS.4 and 7.

More specifically, when the lower portion 51 c of rocker switch 51 ispivoted toward the housing 32, link 56 is pulled back to pivot about pin56 b to a position more aligned with a longitudinal axis of theinstrument as shown in FIG. 9. This in turn pivots rear intermediatelinks 60 a, 60 b to a position more aligned with the longitudinal axisof the instrument, thereby pulling front intermediate link 64 to pivotthe rear portion of curved link 70 (via the connection pin 64 a)downwardly so that cutter spur gear 86 is disengaged from cutter gear 88and grasper spur gear 82 is engaged with grasper gear 84 to lock thegear 84 against sliding movement.

When the upper portion 51 b of rocker switch 51 is pivoted toward thehousing 50, link 56 is pivoted about pin 56 b to a more angled positionas shown in FIG. 4. This in turn pivots rear intermediate links 60 a, 60b to a more angled position, thereby forcing a distal portion of frontintermediate link 64 to move downwardly to pivot curved link 70 (via theconnection pin 64 a) counterclockwise so that grasper spur gear 82 isdisengaged from grasper gear 84 and cutter spur gear 86 is engaged withcutter gear 88 to lock the gear 88 against sliding movement.

Turning now to the movable elements which operably connect the gearswith the jaws, a grasper tube 140 and a cutter tube 150 are provided.More specifically and with reference to FIGS. 2, 3, 4 and 7, extendingfrom grasper gear 84 is grasper tube 140. Grasper tube 140 is attachedto yoke 136 (formed from yoke halves 136 a, 136 b) at its distal end 140a (see FIG. 3). When the grasper handle 40 is actuated to perform thegrasping function, i.e. move the jaws 110, 120 from a closed position toan open position in the grasping orientation, grasper gear 84 is movedproximally from its distal position of FIG. 4 to its proximal positionof FIG. 7, pulling attached grasper tube 140 and attached yoke 136proximally. This moves the jaws 110, 120 from the closed position ofFIG. 5 to the to the open grasping position of FIG. 8 due to theengagement of respective upper and lower pins 123, 113 of upper andlower jaws 120, 110 with respective openings 131 a, 131 b in yoke 136.That is, this pin engagement causes the jaws to pivot about axis “D”transverse to the longitudinal axis “B” of the jaws and instrument andpassing through the side pins 125, 115. To close the jaws 120, 110, thegrasper handle 40 is moved in the opposite direction (distally) back toits normal at rest position, thereby moving grasper gear 84 distally tothereby advance the grasper tube 140 and attached yoke 136 distally,forcing the jaws 120, 110 to pivot about axis “D” back to the positionof FIG. 5. Note that outer tube (elongated member) 20 has slots 20 a(FIG. 3) to accommodate pins 123, 113.

The grasper tube 140 is positioned inside and preferably coaxially withthe cutter tube 150. Cutter tube 150 is slidably mounted within recessesformed in ribs 31 of housing half 32 a and corresponding ribs on housinghalf 32 b. (See FIG. 2). Cutter tube 150 is positioned within shaft 20.

Referring to FIGS. 3, 9 and 12, cutter tube 150 has a proximal endextending from cutter gear 88 and a distal end 150 a. The distal end 150a has holes 152 a, 152 b on respective extensions 153 a, 153 b toreceive side pins 115, 125 of jaws 110, 120, respectively. When thecutter handle 46 is actuated to perform the cutting function, i.e. movethe jaws 110, 120 from a closed position of FIG. 13 outwardly to an openposition of FIG. 11 in the cutting orientation, cutter gear 88 is movedproximally, pulling cutter tube 150 proximally from its distal positionof FIG. 9 to its proximal position of FIG. 12. This moves the jaws 110,120 to an open position due to the engagement of the holes 152 a and 152b of extensions 153 a, 153 b with the side pins 115, 125. This causesthe jaws 110, 120 to pivot about a cutting axis “A” extending transverseto the longitudinal axis of the jaws and instrument and passing throughthe upper and lower pins 123, 113. To close the jaws 110, 120 to cuttissue, the cutter handle 46 is moved in the opposite direction(proximally) to return to its at rest position, thereby moving cuttergear 88 distally to thereby advance the cutter tube 150 distally toforce jaws 120, 110 back to the closed position of FIG. 13. Thus,movement of the first and second jaws in the cutting direction isachieved solely by axial movement of the cutter tube in a singledirection. Note that outer tube (elongated member) 20 has slots 20 b(FIG. 3) to accommodate pins 125, 115.

Shaft 130 has a ball 132 at its distal end 131, preferably integraltherewith, and configured and dimensioned to fit within thehemispherical recesses (e.g. recess 119) of jaws 110, 120, respectively.The hemispherical recesses together form a spherical recess. Shaft 130is supported within a recess in rib 31 b in housing half 32 a and acorresponding rib in housing half 32 b (see FIG. 2).

Turning now to the handle assembly 30 and with initial reference toFIGS. 1 and 2, the assembly 30 includes first and second body halves 32a, 32 b fastened together by conventional methods. The handle assembly30 has a stationary handle or grip 34 with finger loop 28, a movablegrasper handle or actuator 40 with finger loop 42, and a cutting handleor actuator 46 with finger loop 48. As shown, grasper handle 40 ispositioned proximally of stationary handle 34 and cutter handle 46 ispositioned distally of stationary handle 34. Grasping handle 40 isoperably associated with the grasper gear 82 and cutter handle 46 isoperably associated with cutter gear 86. The body halves have slots toreceive the mounting portions of the handles and to accommodate movementof the handles 40, 46.

Referring to FIGS. 2 and 4, yoke 43 of grasper handle 40 has spacedopenings 43 a for mounting to handle pin 37 a of housing 32 a and acorresponding handle pin on housing half 32 b. Yoke 47 of cutter handle46 has spaced openings 43 a for mounting to handle pin 38 a of housing32 a and a corresponding handle pin on housing half 32 b.

Grasper handle 40 has an internal cam slot 49 which is configured toreceive lower gear pin 85 a extending from a lower portion of lowergrasper spur gear 85. In this manner, when grasper handle 40 isretracted, i.e. moved in a proximal direction from the position of FIG.4 to the position of FIG. 7, the cam slot 49 forces lower gear pin 85 aproximally to retract grasper gears 85 and 84 proximally. This retractsthe attached grasper tube 140 to open the jaws 110, 120 in a graspingfashion described above. This movement can be appreciated by comparingFIGS. 4 and 7—FIG. 4 corresponding to the position of the jaws 110, 120in the closed position of FIG. 5; and FIG. 7 corresponding to theposition of the jaws 110, 120 in the open grasping orientation of FIG.8. Movement of the grasper handle 40 distally back to its initial atrest position cams the lower gear pin 85 a distally to move the graspergear 84 distally back to its original position, thereby moving thegrasper tube 140 distally to pivot the jaws 110, 120 back to the closedposition. Note that as shown in FIG. 4, the lower gear pin 85 a is belowand distal of the pivot axis (extending through openings 43 a) ofgrasper handle 40.

Referring to FIG. 9, cutter handle 46 has an internal cam slot 41 whichis configured to receive lower gear pin 89 a extending from lowergrasper inverted spur gear 89. In this manner, when cutter handle 46 ismoved in a distal direction, the lower gear pin 89 a is cammedproximally to move the lower cutter spur gear 89 and cutter gear 88proximally. This retracts the attached cutter tube 150 to open the jaws110, 120 in a cutting fashion described above. This movement can beappreciated by comparing FIGS. 9 and 12—FIG. 9 corresponding to theposition of the jaws 110, 120 in the closed position of FIG. 13; andFIG. 12 corresponding to the position of the jaws 110, 120 in the opencutting orientation of FIG. 11. Movement of the cutter handle 46proximally back to its initial at rest position cams the lower gear pin89 a distally to move the cutter gear 88 distally back to its originalposition, thereby moving the cutter tube 150 distally to pivot the jaws110, 120 back to the closed position. Note in the position of FIG. 7,lower gear pin 89 a is above and distal of the pivot axis (extendingthrough openings 47 a) of cutter handle 46.

The handle assembly provides an ergonomic handle design for moving thejaws as well as a built in safety. This is depicted in FIGS. 1, 6 and 10which illustrate a surgeon's hand engaging the handle assembly 40. Asshown in FIG. 1, both the grasping handle loop 42 and the cutting handleloop 48 of handles 40, 46, respectively, are in the at rest position sothat the jaws 110, 120 are closed. The user's thumb is disengaged fromgrasper loop 42 to access switch 51 on housing 30. The switch 51 is inthe grasping function position.

If the user desires to perform a grasping function, the instrument isheld as shown with the thumb of the user through grasper loop 42 and theforefinger remaining through the cutter loop 48 (alternatively theforefinger can be removed from the cutter loop 48 during the graspingactuation). The middle and ring finger extend through the handle loop 28of stationary handle 34. To open the jaws to grasp tissue, the user withhis/her thumb moves the grasper handle 40 away from the stationaryhandle 34 in the direction of the arrow of FIG. 6. This moves the jaws110, 120 to the open grasping position of FIG. 8. The user then movesthe grasper handle 40 distally. i.e. back towards the stationary handle34 to move the jaws 110, 120 toward each other to grasp tissuetherebetween. The jaws 110, 120 move such that the top surface of thebottom jaw 110 and the bottom surface of the top jaw 120 move towardeach other in a pivoting fashion.

To switch to the cutting function, the instrument 10 is grasped as shownin FIG. 10 with the thumb of the user removed from the grasper loop 42to access switch 51. Switch 51 switches the linkage mechanism of theinstrument between a grasping and a cutting function such that only onefunction can be operable at a time as described in detail above. Switch51 can be activated by the single hand of the user only when the jawsare in the closed position. The ergonomic design of the handle achievesthis as: 1) the thumb of the user needs to be removed from the grasperloop 42 to access the switch 51 so that the grasper handle 40 can nolonger be held in its outward (open) position to open the jaws; and 2)to reach the switch 51 with the thumb, the grasper handle 40 is blockedin the inward (closed) position by the palm of the user's hand as shownin FIG. 10. A safety mechanism can also be provided to ensure the switch51 can be activated only when the jaws 110, 120 are closed. This isdescribed below in conjunction with the embodiment of FIG. 15.

After the switch 51 is rotated to the cutting position by pressing thelower portion 51 c of the switch 51, it actuates the linkage mechanismas described above to lock the grasper gear 84 and grasper handle 40 tothereby lock movement of the jaws 110, 120 in a grasping function. Toeffectuate cutting, the forefinger of the user remains in the cutterloop 48 of cutter handle 46 and the thumb remains either outside thegrasper loop 42 of grasper handle 40, resting on the rear of housing 32as shown in FIG. 1 or inside the lop 42 as in FIG. 6. The remainingfingers are also in the same position as in the grasping and switchingfunction, i.e. the middle and ring fingers extending through the handleloop 28 of stationary handle 34. A groove 31 can optionally be providedon stationary handle 34 for resting of the small finger.

To open the jaws in a scissor like fashion to cut/sever tissue, the userwith his/her forefinger moves the cutter handle 46 away from thestationary handle 34. This moves the jaws 110, 120 to the open cuttingposition of FIG. 11. To close the jaws 110, 120, the grasper loop 46 ismoved back towards the stationary handle 34. Note, as described above,in the cutting function, the jaws 110, 120 move such that the inneredges of the jaws move toward//across each other in a scissor likefashion. This can be appreciated by comparing FIGS. 11 and 13.

If the user wants to return to the grasping function, the user graspsthe handle assembly 30 in the manner shown in FIG. 1 and presses theupper portion 51 b of switch 51 to pivot the switch 51 from the positionof FIG. 10 to the position of FIG. 1. This actuates the linkagemechanism to lock the cutter gear 88 and cutter handle 46 as describedabove (and releases the grasper spur gear lock on the grasper gear 84).The user can then grasp the instrument as shown in FIG. 6 to move thejaws 110, 120 in a grasping function. As can be appreciated, theinstrument is designed so it can't be switched with the grasping hand ofthe user between cutting and grasping functions unless the jaws 30 arein the closed position.

In addition or as an alternative to the ergonomic design having thisbuilt in safety, a safety mechanism 160 can also be provided. This isshown in the alternative embodiment of FIGS. 15 and 16. The embodimentof FIG. 15 is identical to the embodiment of FIG. 1 except for thesafety mechanism and the apertures in the switch. Therefore, theactuator handles, links, etc. have not been labeled for clarity.Corresponding parts with the FIG. 1 embodiment discussed in conjunctionwith the safety mechanism 160 have been given “prime” designations.

The safety mechanism 160 includes a slidable locking plate 171 having apost 172 extending from a proximal portion 174. Spring 176 biases thelocking plate 172 in a distal direction. Inner tab 178 at the proximalportion 174 abuts or engages the rear wall of the grasper gear 84′ andinner tab 179 at the distal portion 175 of plate 171 abuts or engagesthe rear wall of the cutter gear 88′. In the closed position of the jaws110, 120, both grasper gear 84′ and cutter gear 88′ are in the forwardposition. In this position, the locking plate is biased distally byspring 176, out of engagement with switch 180.

If the jaws are in the open cutting position, cutting gear 88′ is in theretracted position of FIG. 16, which moves locking plate 171 to aretracted position against the force of spring 176. In this retractedposition, the post 172 is positioned in a lower aperture 181 a of theswitch 180. In this position, the switch 180 cannot be moved as itspivotable movement is blocked. Similarly, if the jaws are in the opengrasping position, (with the switch 51 in the grasping function positionwith the upper portion 51 b closer to the housing 32) grasper gear 84′is in the retracted position, which moves locking plate 171 to aretracted position against the force of spring 176. In this retractedposition, the post 172 is positioned in an upper aperture 181 b of theswitch 51 to prevent pivotable movement of the switch 180. Note besidesthe apertures 181 a, 181 b, switch 180 is identical to switch 51described above.

The use of the instrument will now be described. For purposes of thisdescription, the instrument is packaged with the switch 51 in thegrasping function position so it's initially ready for grasping;however, the instrument can alternatively be packaged with the switch 51in the cutting function position. Note that the switch 51 preferablyincludes indicia on its rear surface so the user has a visual indicationof which function the switch 51 is engaged. Also, throughout thedescription of use, reference is made to how the safety mechanism 160 ofFIGS. 15 and 16, if utilized, would function.

In the initial position of the instrument 10 shown in FIG. 1, thegrasper handle 40 is in the forward (distal) position, spaced closer tothe stationary handle 34 so that jaws 110 and 120 are in the closedposition of FIG. 5. The cutter handle 46 is in the retracted (proximal)position, closer to the stationary handle 34. The instrument 10 isinserted through an access port or opening with the jaws 110, 120closed.

In this initial position, the switch 51 is in the grasping position suchthat upper portion 51 b is angled toward the handle housing 30 and thelower portion 51 c is angled away from the housing 32. In this position,shown in FIG. 4, rocker engaging link 56 is angled upwardly (in theorientation of FIG. 4), causing rear intermediate links 60 a, 60 b, tobe angled upwardly. This results in front intermediate link 64 applyinga force to curved link 70 so the curved link 70 is pivoted forwardly(counterclockwise) about central housing pin 73 toward cutter gear 88 tomove teeth 86 a of cutter spur gear 86 into engagement with the teeth 88a of cutter gear 88. Consequently, this intermeshing of the teeth 86 aand teeth 88 a locks gear 88 so movement is prohibited. Thus, the usercannot move cutter handle 46 and cannot advance cutter actuator 150.With the locking of cutter handle 46, the user is prevented fromconfusing the cutting and grasping function. Note that the teeth 82 a ofthe grasper spur gear 82 in this position are spaced (disengaged) fromthe teeth 84 a of the grasper gear 84 to allow movement of gear 84.

Note also in the closed position of the jaws 110, 120, the cutter gear88 and grasper gear 84 (and lower spur gears 85, 89) are in the forwardposition so that in the embodiment of FIGS. 15 and 16 utilizing safetymechanism 160, safety plate 171 is in the forward position. In thisforward (disengaged) position, the proximal post 172 of safety plate 171is disengaged from the switch 180 and is spaced distally from theapertures 181 a, 181 b to enable pivoting movement of switch 180.

The instrument 10 is inserted with the jaws 110, 120 closed through anaccess port or opening and advanced toward the surgical site. If thesurgeon desires to use the grasping function, the user retracts grasperhandle 40 in the direction of the arrow of FIGS. 6 and 7, moving it awayfrom the stationary handle 34. When the grasper handle 40 is moved inthis direction, handle 40 pivots about handle mounting pin 37 a (FIG. 2)and forces gear 84 proximally via engagement of grasper lower gear pin85 a of attached lower spur gear 89 in cam slot 49 (FIG. 7). This causesretraction of grasper tube 140 to retract attached yoke 136 which pivotsthe jaws 110, 120 about pivot axis D (FIG. 5) in the graspingorientation from the closed position to the grasping open position ofFIG. 8 via the engagement of upper and lower jaw pins 123, 113.

Note that in this retracted position of the grasper gear 84, if thesafety mechanism 160 of FIG. 15 is utilized, safety plate 171 islikewise retracted (due to its abutment with the back of the graspergear 84). In this retracted position, post 172 is positioned withinaperture 181 b of switch 180. This prevents movement of switch 51 so theuser cannot switch from the grasping function to the cutting function ifthe jaws 110, 120 are in the open position.

To close the jaws in this grasper function to grasp tissue positionedbetween the jaws 110, 120, grasper handle 40 is moved in the oppositedirection (distally toward stationary handle 34) thereby moving graspergear 84 via lower gear pin 85 distally to advance grasper tube 140 sojaws 110, 120 can pivot about pivot axis D back to the closed positionof FIG. 5.

If the surgeon desires to switch to the cutting function of theinstrument 10, the user pivots switch 51 to its cutting functionposition by pressing lower portion 51 c toward housing 32 so that thelower portion 51 c is closer to handle housing 32 and the upper portion51 b is positioned further away from housing 32 as shown in FIG. 10.Note that detents 51 a of switch 51 are moved from engagement with upperslot 33 b in housing half 32 a (FIG. 2) into engagement with lower slot33 a of housing half 32 a (and a corresponding slot in housing half 32b) to provide a tactile indicator that the switch 51 is in the cuttingposition as well as to maintain the switch 51 in this position so theuser does not need to hold the switch 51.

Such pivoting motion of switch 51 pulls attached link 56 proximally,which in turn pulls rear intermediate link 60 a 60 b proximally to themore linear position of FIG. 9. This forces front intermediate link 64to pivot curved link 70 in a clockwise direction about central mountingpin 73. This clockwise movement lifts cutter spur gear 86 out of lockingengagement with cutter gear 88 and moves grasper spur gear 82 intolocking engagement with grasper gear 84. In this grasper lockingposition, teeth 82 a of spur gear 82 intermesh with teeth 84 a ofgrasper gear 84 so that movement of the grasper gear 84 is prohibited.Thus, the user cannot move grasper handle 40 to actuate grasper tube140.

Note again that if the safety mechanism 160 of FIGS. 15 and 16 is used,in the closed position of the jaws 110, 120, the safety plate 171 is inthe forward position as both the cutter gear 88 and grasper gear 84 arein the forward position. In this forward (disengaged) position, theproximal post 172 of safety plate 171 is disengaged from the apertures181 a, 181 b of switch 180 as it is spaced distally from the apertures.

To move jaws 110, 120 in a cutting function, the user moves cutterhandle 46 distally, moving it in a direction away toward stationaryhandle 34 as shown in FIG. 12. When the cutter handle 46 is moved inthis direction, cutter handle 46 pivots about handle mounting pin 38 a(FIG. 2) and cutter lower gear pin 89 a of lower inverted spur gear 89(attached to cutter gear 88) is cammed rearwardly by internal cam slot47 of cutter handle 40. This causes retraction of cutter gear 88 whichretracts attached cutter tube 150. Retraction of cutter tube 150 pivotsthe jaws 110, 120 about pivot axis A in the cutting orientation to anopen cutting position as side pins 115 and 125 are engaged by extensions153 a, 153 b of cutter tube 150 (see FIG. 11).

Note that in this retracted position of the cutter gear 86, safety plate171, if provided, is likewise retracted (due to its abutment with theback of the cutter gear 86). In this retracted position, post 172 ispositioned within aperture 181 a of switch 180. This prevents movementof switch 180 so the user cannot switch from the cutting function to thegrasping function if the jaws 110, 120 are in the open position.

To close the jaws 110, 120, the cutter handle 46 is moved proximallytoward the stationary handle 34 back to its at rest position, therebyadvancing the cutter gear 86 and cutter tube 150 distally.

As can be appreciated, if the user desires to switch from the cuttingfunction to the grasping function, switch 51 is pivoted so upper portion51 c is pressed toward the housing 32. As noted above, the jaws 110, 120need to be in the closed position to activate the switch 51 because ofsafety plate 171. Detents 51 a are moved from upper recess 33 b to upperrecess 33 a of housing 32, again providing a tactile indicator that theswitch 51 is in position. Such pivoting motion of the switch 51 forceslinks 56 and 60 a, 60 b, to the angled position of FIG. 4, causingintermediate link 64 to rotate curved link 70 in a counterclockwisedirection to lift grasper spur gear 82 out of engagement with graspergear 84 and to move cutter spur gear 86 into locking engagement withcutter gear 88. Thus, as described above, cutter handle 46 is locked andcannot be moved and the jaws 110, 120 can be opened in a graspingfunction. Safety plate 171 is out of locking engagement with switch 51.

As can be appreciated, the user can activate the switch to choosebetween the cutting and grasping functions as often as desirable. Thus,for example, in a laparoscopic cholecystectomy procedure, the surgeoncan use instrument 10 to dissect tissue with the open jaws 110, 120,sever the duct with the jaws 110, 120 and then grasp the gall bladderwith jaws 110, 120, avoiding the need for multiple instruments andinstrument exchanges.

It should be appreciated that the instrument can alternatively beprovided with different jaws to perform other functions beside graspingand cutting. The switching mechanism would enable switching between thetwo different functions.

While the above description contains many specifics, those specificsshould not be construed as limitations on the scope of the disclosure,but merely as exemplifications of preferred embodiments thereof. Thoseskilled in the art will envision many other possible variations that arewithin the scope and spirit of the disclosure as defined by the claimsappended hereto.

What is claimed is:
 1. A surgical instrument for grasping and cuttingtissue comprising: an elongated member having a proximal portion and adistal portion; a first jaw and a second jaw adjacent the distal portionof the elongated member, the first jaw having a first projecting memberextending outwardly from the first jaw in a first direction and a secondprojecting member extending outwardly from the first jaw in a seconddirection transverse to the first direction, the first projecting memberoperably connected to a first movable member and the second projectingmember operably connected to a second movable member, the first andsecond movable members being independently movable; an actuatingmechanism for moving the first movable member in a first direction tomove at least the first or second jaw in a grasping direction in agrasping action and for further moving the second movable member in asingle direction to move at least the first or second jaw in a cuttingdirection in a cutting action different than the grasping direction, thesecond movable member itself effecting movement of at least the firstjaw or the second jaw in the cutting direction; and a shaft positionedwithin the elongated member and a ball at a distal portion of the shaft,wherein the first jaw and second jaw have a proximal recess dimensionedto receive the ball.
 2. The surgical instrument of claim 1, wherein thefirst and second jaws pivot in a grasping action about a first pivotaxis in planes at acute angles to each other.
 3. The surgical instrumentof claim 1, wherein the first and second jaws move away from each otherin substantially parallel planes about a second pivot axis in thecutting action.
 4. The surgical instrument of claim 1, wherein the firstjaw moves at an acute angle to the second jaw about a first pivot axisin the grasping action and moves away from the second jaw about a secondpivot axis in a substantially parallel plane to the first jaw in thecutting action and the first and second pivot axes intersect.
 5. Thesurgical instrument of claim 1, wherein the second jaw has a thirdprojecting member extending outwardly from the second jaw in a thirddirection and a fourth projecting member extending outwardly from thesecond jaw in a fourth direction transverse to the third direction, thethird projecting member operably connected with the first movable memberand the fourth projecting member operably connected to the secondmovable member.
 6. The surgical instrument of claim 5, wherein the firstand third projecting members lie substantially along a same axis and thesecond and fourth projecting members lie substantially along a same axiswhich intersects and is transverse to the axis passing through the firstand third projecting members.
 7. The surgical instrument of claim 6,wherein the second movable member includes a yoke having openings toreceive the first projecting member of the first jaw and the thirdprojecting member of the second jaw, wherein proximal movement of theyoke moves the first and second jaws in the grasping action, wherein thefirst movable member includes a first tube and the second movable memberincludes a second tube, and the yoke is connected to the first tube, andthe first tube is positioned inside the second tube operativelyconnected to the first and second jaws.
 8. The surgical instrument ofclaim 5, wherein the second movable member is the sole member to moveboth the first and second jaws in the cutting action.
 9. The surgicalinstrument of claim 8, wherein the first and second movable members arecoaxial and are elongated tubular members.
 10. The surgical instrumentof claim 1, wherein the first and second jaws each have a linear regionand an arcuate region.
 11. The surgical instrument of claim 1, whereinthe actuating mechanism includes a first actuator to move the firstmovable member and a second actuator to move the second movable member.12. The surgical instrument of claim 1, further comprising a safetymechanism which prevents switching movement from a grasping function toa cutting function if the first and second jaws are in an open position.13. A surgical instrument for grasping and cutting tissue comprising: anelongated member having a proximal portion and a distal portion; a firstjaw and a second jaw adjacent the distal portion of the elongatedmember, the first jaw having a first recess at a proximal portion, afirst projecting member extending outwardly from the first jaw in afirst direction and a second projecting member extending outwardly fromthe first jaw in a second direction transverse to the first direction,the first projecting member operably connected to a first movable memberand the second projecting member operably connected to a second movablemember, the second jaw having a second recess at a proximal portion, athird projecting member extending outwardly from the second jaw in athird direction and a fourth projecting member extending outwardly fromthe second jaw in a fourth direction transverse to the third direction,the third projecting member operably connected with the first movablemember and the fourth projecting member operably connected to the secondmovable member, the first and second movable members being independentlymovable; an elongated shaft positioned within the elongated member, anda ball shaped engagement member at a distal portion of the elongatedshaft engaging the first and second recesses of the first and secondjaws; and an actuating mechanism actuable to move the first and secondjaws in a grasping direction in a grasping action and to move the firstand second jaws in a cutting direction in a cutting action differentthan the grasping direction.
 14. The surgical instrument of claim 13,wherein the shaft and ball are held in tension by a spring.